经半椎板入路并椎板复位治疗胸椎椎管内肿瘤(附16例报告)

Microsurgery including reduction of vertebral hemilaminae through unilateral hemilaminectomy approach for the thoracic intraspinal tumors (report of 16 cases)

目的探讨半椎板入路手术并椎板复位术在切除胸椎椎管内肿瘤显微手术中的应用价值。方法采用半椎板入路手术并椎板复位术治疗胸椎椎管内肿瘤16例。术前患者神经功能按Frankel分级，A级1例，B级2例，c级7例，D级5例，E级l例。术后随访12—30个月[平均（19．7±5．4）个月]，随访内容包括Fankel分级，以及有无脊柱不稳或畸形。结果手术时间72—155min[平均（119．5±23．0）min]。术中铣开1个椎板2例，2个椎板12例，3个锥板2例。术后行CT三维成像检查均显示椎板固定良好，无脑脊液漏或皮下积液病例。随访时Frankel D、E级病人的比例由入院时的37．5％（6，16）上升到随访时的81．2％（13／16），两者相差显著（P〈0．05）；随访时均未见脊柱畸形或脊柱不稳者。结论胸椎椎管内肿瘤手术较适合采用半椎板入路，术中同时行胸椎椎板复位能最大限度地保留脊柱的完整性和稳定性，减少术后并发症的发生。

Objective To explore the application of unilateral hemilaminectomy approach and the reduction of vertebral bemilamina to the microsurgery for the thoracic intraspinal tumors. Methods The microsurgery through the unilateral bemilaminectomy approach and the reduction of the vertebral hamilaminae were performed in 16 patients with thoracic intraspinal tumors. The pre-and post-operative neurological functions were assessed by Frankel grade. Results The operative duration ranged from 72 to 155 minutes [mean, （119.5±23.0） minutes]. Of 16 patients, 2 received opening 1 vertebral lamina, 12 opening 2 laminae and 2 opening 3 laminae. Three dimensional CT after the operation showed that all the laminae were reconstructed well. The cerebrospinal leakage and pseudomeningocele did not occur in all the patients who were followed up from 12 to 30 months [mean, （19.7 ± 5.4）months]. The percentage （81.25%, 13/16） of the patients with Frankel grades D and E on the following-up was signitlcanfly higher than that （37.50%, 6/16） before the surgery （P〈0.05）. There were not the spinal deformity and spinal instability during the following-up in all patients. Condusiolls The microsurgery including the reduction of the vertebral laminae through the unilateral bemilaminectomy approach is -suitable for treating the thoracic intxaspinal tumors. The reduetion of the vertebral lamina is very helpful to the spinal stability and integrality, and reducing the pestoporative complications.